Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Thursday, March 20, 2008

Hot Stuff

A word or two about applying heat to treat inflammation or infections of body parts. Based on absolutely no current research other than what I've learned and observed, this is my take on it. The reason I mention it: I'm applying a little heat to the area of me which is most in contact with my bicycle saddle. Let's keep that between you and me.

Why is heat useful? Because it increases circulation to the area in question: capillaries dilate, blood flows in, which is good in two ways. It carries with it the body's own defenses (ie, white blood cells of various types), and, assuming you might be on antibiotics, it brings more of that, too.

Why "moist" heat? Nothing magic about moisture, per se. It doesn't get below a couple of cell layers, after all. It's about conforming to the part you're trying to heat: a moist cloth will lay entirely against the skin, whereas a heating pad has gaps in its contact.

What's a Koch-Mason dressing? Wow, where did you hear of that? I can't even find it on Google. It's an old-style multi-layer dressing intended to apply continuous heat: on the skin, a warm moist cloth of some sort; then plastic wrap; then some variety of heating pad; then a dry towel above that. In the olden days, we used them, in the hospital, for some people with cellulitis. You need to be careful about the heating pad. The hospital kinds use warm water circulating in the pad. Electric ones pose hazards, both from the electricity and from over-heating.

What's your secret, Sid? Well, you asked, so here it is. If you want to apply constant heat to an extremity, and don't want to be tied down by an electric cord (most assuredly, this is not a fetish blog) do this: cover the area with a nice warm moist cloth, then wrap with plastic wrap, then follow with a dry towel, and tape it all in place. The insulation will keep the heat in, and you can be up and around. The area will be significantly warmer than the rest of you. Because of the moisture, it's good to remove the whole thing every few hours to prevent dishpan hands of the leg, or whatever.

There's always a catch: applying heat to an extremity that has circulatory compromise can be dangerous. Even if you have a minor booboo, don't be using heat when there are vascular problems without having your doctor in the loop.

10 comments:

Very entertaining post, Dr. S. And once again, you demonstrate eerily perfect timing. I just got off the phone with a grandparent who has shingles (again), and she claims that only heat (shower, warm cloth) is alleviating her discomfort. I'll share the Koch-Mason dressing details with her. Thanks!

I couldn't agree more with this. I have had OA in many joints for years. it seems the OS is always saying "ice, ice and more ice." But I have found over the last 25 years, that heat works far better for me than what ice does. In fact I avoid ice for it. There are times when it is called for and I have used it, such as after having a joint relaced, I use ice for post op swelling, but for everyday treatment it is heat for me. Also heated therapy pools works wonders on joints.

Thank you for the tip about moist heat and placing plastic wrap over it. i'm gonna give that a try.

Dr. Schwab,I was just thinking about basically this yesterday when my daughter took a spill and her wrist swelled up. Nothing was broken and we put ice on it and everything was fine, but it was also popped out of joint (which her wrist is prone to do). When I had carpal tunnel the doctor or nurse always told me to put heat on my wrist and hand as heat is good for nerve pain.

If you don't mind my asking, I've always been curious as to why it is that heat helped greatly in the early stages of my autoimmunity, when they were thinking probably rheumatoid arthritis, but as it morphed over a few months into SLE, heat caused rather than ameliorated pain and the Therabath went into storage. Eighteen years later, it's still the case. Ice for my joints only!

Alison: I think there are many factors, and it's hard to generalize, even about such things as heat and cold. For pain relief per se, cold is generally better. Also, by increasing blood flow heat can sometimes increase swelling. So whether one works better than the other depends on what exactly is being treated. With infection, for the reasons I mentioned, heat is better. For pain and swelling, ice may be. It also depends on whether the issue is acute or chronic.

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.